How to Create a Culture of Good Health Health isn't just about doctors and diet. It's about our emotions and environment too.

YES! Illustration by Pablo Iglesias

Mind + Body + Community = A Better Health Equation

Dr. Gabor Maté

YES! Illustration by Pablo Iglesias

"I never get angry," says a character in one of Woody Allen's movies. "I grow a tumor instead." Much more scientific truth is captured in that droll remark than many doctors would recognize. Mainstream medical practice largely ignores the role of emotions in the physiological functioning of the human organism. Yet the scientific evidence abundantly shows that people's lifetime emotional experiences profoundly influence health and illness. And, since emotional patterns are a response to the psychological and social environment, disease in an individual always tells us about the multigenerational family of origin and the broader culture in which that person's life unfolds.

Gabor Maté, M.D., frequently addresses lay and professional audiences across North America and internationally. His books include When the Body Says No: Exploring the Stress-Disease Connection and In the Realm of Hungry Ghosts: Close Encounters With Addiction. Follow his website drgabormate.com.

We human beings are biopsychosocial creatures whose health or illness reflects our relationship with the world we inhabit — including all the variables of family, class, gender, race, political status, and the physical ecology of which we are a part. A recent article from the National Institutes of Health called for a new foundational theory for medicine, based on a “biopsychosocial-ecological paradigm.” Given the ideological limitations of mainstream medicine, this forward-looking initiative is not likely to be heeded soon.

As early as the second century, the Roman physician Galen noted the connection between emotional burden and illness, an observation repeated by many other clinicians over the centuries. The pathway from stressful emotions, often unconscious, to physical disease was often driven home to me as a family physician and palliative care practitioner, although nothing in my medical education even remotely hinted at such links. People I saw with chronic disease of all kinds—from malignancies or autoimmune conditions such as rheumatoid arthritis or ulcerative colitis to persistent skin conditions such as eczema and psoriasis, and neurological disorders like Lou Gehrig’s Disease (ALS), multiple sclerosis, Parkinson’s, and even dementia — were characterized by certain unmistakable emotional life patterns. Among these was the chronic repression of so-called negative emotions, especially of healthy anger, as in the Woody Allen character’s wry confession; an overriding sense of duty, role, and responsibility; an undue concern for the emotional needs of others while ignoring one’s own; and, finally, a core belief — again, often unconscious — that one is responsible for how other people feel and that one must never disappoint others. The expression “the good die young” has — sadly — more validity than we sometimes appreciate.

A materialistic culture teaches its members that their value depends on what they produce, achieve, or consume rather than on their human beingness.

Exemplifying the characteristic of an overwrought sense of duty, role, and responsibility, New York Times contributor Julia Baird recently reported her diagnosis with ovarian cancer. “I have always been healthy and strong,” she wrote in a recent column. “I regularly do hot yoga and swim a two-kilometer stretch in a bay teeming with fish near my home in Sydney, all while caring for my two little kids, hosting a TV show, writing columns and making the final edits on the book I am writing.” Inadvertently, Baird depicts precisely the “I can do anything, I’ll be everything to everybody” multitasking persona I found in everyone I ever met with her particular malignancy. People are unaware, and their physicians rarely know to inform them, that such self-imposed stress is a major risk factor for disease of all kinds.

But is it purely self-imposed? It is not accurate to see it that way. A materialistic culture teaches its members that their value depends on what they produce, achieve, or consume rather than on their human beingness. Many of us believe that we must continually prove and justify our worthiness, that we must keep having and doing to justify our existence.

From the Editors: Mind + Body + Community

Erin Sagen, Sarah van Gelder, & Clo Copass

A culture of good health is one we can't achieve alone. Our vitality is affected by every little thing in our lives: not only our bodies and minds, but also our culture, our economy, our relationships, and our environment.

“We human beings are biopsychosocial creatures whose health or illness reflects our relationship with the world we inhabit — including all the variables of family, class, gender, race, political status, and the physical ecology of which we are a part.” —Dr. Gabor Maté

From the Editors: Mind + Body + Community

Erin Sagen, Sarah van Gelder, & Clo Copass

Sagen

van Gelder

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Copass

Winter can be a difficult season. Shorter days and bleak weather leave us drained of energy. And then come the holidays, with celebrations and family get-togethers, which are a source of joy for some and anxiety for others. If we succumb to the weather and the stress, we might start mistaking our mental and physical struggles for personal failure. We’ve all heard the message that our health is our own problem, that if we get sick or depressed, it’s because we did something wrong or are not “taking care of ourselves.”

This seemed like a good time for YES! to ask what actually nourishes a culture of good health. As we explored this question, we learned that we don’t have to go it alone. In fact, we can’t go it alone. Research says our vitality is affected by every little thing in our lives: not only our bodies and minds, but also our culture, our economy, our relationships, and our environment. Research suggests that we’re more affected than we previously thought by these diverse systems, which can be as small-scaled as cells and as large as our socioeconomic institutions. Our well-being is as influenced by income inequality as it is by the nutrients in our food.

Even the dirt covering homegrown vegetables could bolster your health and mood, writes Dr. Daphne Miller. Microorganisms found in plants, animals, soil, water, and air might help regulate our immune and nervous systems and reduce anxiety and depression. Although this research is still new, evidence suggests that both physical and psychological health depend on healthy and diverse microbial ecosystems within us.

Our health also depends on nurturing social networks. Author Jasmine Aguilera describes a fascinating paradox: Despite experiencing high poverty rates and cultural marginalization, Hispanics tend to live longer on average than any other group in the country. How is that possible? Culture and community. From eating whole, traditional foods to caring for mothers after their babies are born, these Hispanic families pass down customs that sustain good health.

The stories in this issue might upend some of your ideas about what makes real and sustainable health. To be healthy, we need to embrace our emotional ups and downs; we need to look around and trust that what surrounds us also sustains us; we need to let go of conceptualizing health and instead experience it firsthand, listening to the rhythms of our minds, bodies, and spirits, and honoring everything we see, hear, touch, and smell as vital to who we are and how we live. It’s humbling to realize that our well-being relies on these systems — larger than us but also smaller than we can imagine — so much more than our health insurance company or choice of doctor. But it’s also empowering.

Erin Sagen, Sarah van Gelder, and Clo Copass led the development of this issue's In Depth section.

Lou Gehrig, the baseball great after whom ALS is named, embodied self-abnegation to the nth degree, as do all people with ALS I have ever treated, interviewed, or read about—or have been described in medical papers. His famous record of consecutive games played was not about his indestructibility, but about his unwillingness to surrender his self-identity as invulnerable, with no needs. He suffered injuries like all other athletes: All his fingers had been broken at least once; some more often. He would play even when wincing with pain and sick to the stomach with the agony of it, but his dutifulness would not allow him to rest.

Gehrig’s story, as those of many people with chronic illness, leaves us with the question of how such emotional patterns help potentiate physical illness. Why do people develop and maintain such self-harming traits?

Compulsive self-disregard and emotional repression are never deliberate or conscious — nobody can be faulted for them. They begin in early childhood as coping mechanisms. Gehrig, for example, had an alcoholic father and a highly stressed mother. As a child, he assumed the shell of invulnerability because the responsibility thrust upon him was that of being the emotional caregiver to his parents. Such role reversal, said psychiatrist John Bowlby, the pioneer of attachment research and theory, is inevitably a source of pathology for the child later on. Gehrig was compelled in his childhood to develop a persona that, in time, became his ineluctable self-identity. This is how he adapted to his dysfunctional environment; he knew himself no other way.

A recent article in the journal Pediatrics well summarized the notion that early childhood coping dynamics may result in adult illness and dysfunction:

“Short-term physiologic and psychological adjustments that are necessary for immediate survival and adaptation … may come at a significant cost to long-term outcomes in learning, behavior, health, and longevity.”

During our dependent and vulnerable childhoods we develop the psychological, behavioral, and emotional composite that later we mistake for ourselves. This composite, which we call the personality, often masks a real person with real needs and desires. The personality is not a fault—in stressed environments it evolves primarily as a defense, a defense that can turn saboteur.

The separation of mind and body is an erroneous view, incompatible with science. Personality traits—that is, psychological patterns—conduce to disease because the brain circuits and systems that process emotions not only exert a profound influence on our autonomic nerves, as well as our cardiovascular, hormonal, and immune systems: In reality, they are all conjoined. The recent, but no longer new, discipline of psychoneuroimmunology has delineated the many neurological and biochemical mechanisms that unite all these seemingly disparate systems into one super-system.

A somewhat breathless report in Science Daily outlined the latest such finding, from the University of Virgnia:

“In a stunning discovery that overturns decades of textbook teaching, researchers have determined that the brain is directly connected to the immune system by vessels previously thought not to exist. The discovery could have profound implications for diseases from autism to Alzheimer’s to multiple sclerosis.”

In effect, when we repress emotions—just as when we are completely at their mercy, such as in moments of untrammeled rage—we are playing havoc with our nervous system, hormonal apparatus, immune system, intestines, heart, and other organs. The result can be chronic or acute illness. As repressed anger eventually turns against us, the immune system can as well, as in autoimmune disorders, for example.

The medical profession is traumaphobic. —Colleague of Maté

Interactions between the brain and body also determine that adverse early childhood circumstances — even in utero experiences — leave us in the long term with more than psychological and emotional effects. The physical impact of early childhood experiences can also directly promote disease. Studies from the United States and New Zealand have shown, for example, that healthy adults who suffered childhood mistreatment were more likely to have elevated inflammatory products in their circulation in response to stressful experiences. Such overactive stress reactions are, in turn, a risk factor for conditions such as heart disease, diabetes, and a host of other illnesses.

It is impossible to overstate the impact of childhood trauma on adult mental and physical health. Myriad studies have demonstrated that early-life suffering potentiates many illnesses, from mental diseases such as depression, psychosis, or addiction to autoimmune conditions to cancer. One Canadian study demonstrated that childhood abuse raised the risk of cancer nearly 50 percent, even when controlled for lifestyle habits such as smoking and drinking.

Addictions in particular are responses to early trauma. Whether to drugs, food, gambling, or whatever other form they take, all are attempts to soothe stress and emotional pain. The first question is never why the addiction, but why the pain? We cannot understand the addictions that beset our society without recognizing the suffering and stress they are intended to alleviate, or the childhood trauma at their source. In this light, the obesity epidemic now facing us reflects primarily an epidemic of pain and stress.

Income Inequality Is a Health Hazard — Even For the Rich

Astonishing to say, most medical students never hear the word “trauma” in all their years of training, except in the the sense of physical injury. “The medical profession is traumaphobic,” a well-known colleague in San Francisco once told me. The results for patient care are devastating, whether in the treatment of physical or psychiatric conditions — a distinction that, given the mind/body unity, is in itself misleading.

Individual family dynamics unfold in the context of culture and society. Just as families have their histories in which they transmit trauma across the generations, so do societies. We can see, then, why the poor and the racially oppressed and the historically traumatized are more prone to disease. Need we mention the high rates of alcoholism, violence, obesity, diabetes, and overdose deaths amongst aboriginal populations in North America and, say, Australia, or the relatively unfavorable health outlook and life expectancy of black Americans?

The effects of trauma become multigenerational through repeated psychological dysfunctions. The new science of epigenetics is identifying the mechanisms that even affect gene functioning. The children of Holocaust survivors, for example, have altered genetic mechanisms leading to abnormal stress hormone levels. Animal studies are showing that the physiological effects of trauma can be passed on even to the third generation.

Finally, family stresses, trauma, and social and economic deprivation can also affect human brain development in ways that lead to behavioral problems, learning disabilities, and mental illness. CT scan studies at the University of Wisconsin showed that brain centers responsible for academic performance were up to 10 percent smaller in children who grew up in the poorest homes. Why? Because the human brain itself is a social organ, shaped in its neurophysiological and neurochemical development by the child’s relationships. In the words of the above-cited Pediatrics article:

“The interaction of genes and experiences literally shapes the circuitry of the developing brain, and is critically influenced by the mutual responsiveness of adult-child relationships, particularly in the early childhood years.”

Parents stressed by multigenerational trauma, relationship issues, economic insecurity, maternal depression, or social disconnection are simply unable to give their children the “mutually responsive” attuned interactions that optimal childhood development requires. The result is the epidemic of developmental disorders among our children that we are now witnessing. In line with the prevailing ideology, the medical response is mostly pharmaceutical. Rather than considering the environment that, throughout childhood, shapes the brain, we seek to manipulate the child’s brain chemistry instead.

What then are people to do when doctors, the gatekeepers to health care and its primary providers, are blind to the basic realities of what generates health and what undermines it? When their training denies them knowledge of the unshakeable unity of mind and body, of emotions and physiology? When they do not recognize that social factors are far more powerful determinants of health than genetic predispositions? When they are unaware of the powerful role of psychological trauma in human life?

Take responsibility for how you live, the food you ingest, your emotional balance, your spiritual development, the integrity of your relationships.

On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support. In this alienated culture, where “friends” may be virtual electronic entities rather than human beings, too many suffer from what University of Chicago psychologist John Cacioppo calls “the lethality of loneliness.” We need a broad attitudinal and practical shift, consciously willed and created, toward a culture based on the fundamental sociality of human beings. We know all too well, from data too persuasive and too somber to be disputed, that emotional isolation kills.

Policymakers and community leaders need to be taught that economic and social disparities, insecurities, and stresses, as well as racial or ethnic inequalities, inevitably result in health problems and vastly increased health costs. In truth, almost all diseases are social diseases.

Health promotion must begin at conception. In the womb the growing human is already affected by maternal stress. Pregnant women need much more than blood tests, physical exams, and ultrasounds. They require emotional support so the hormones of stress do not chronically flow into the fetus via the umbilical cord. Current birthing practices, egregiously over-medicalized, interfere with natural physiologic processes and maternal-infant bonding.

With the role of parental presence and attunement being recognized in brain and personality development, young mothers and fathers must be helped to spend much more time with their children. In advanced European countries even fathers are accorded parental leave.

Adults need to know, even if their physicians often do not, that their health issues are rarely isolated manifestations. Any symptom, any illness is also an opportunity to consider where our lives may be out of balance, where our childhood coping patterns have become maladaptive, exacting costs on our physical well-being.

When we take on too much stress, whether at work or in our personal lives, when we are not able to say no, inevitably our bodies will say it for us. We need to be very honest with ourselves, very compassionate, but very thorough in considering how our childhood programming still runs our lives, to our detriment.

Ultimately, healing flows from within. The word itself originates from “wholeness.” To be whole is much more than to experience the absence of disease. It is the full and optimal functioning of the human organism, according to its nature-gifted possibilities. By such standards, we live in a culture that leaves us far short of health.

The importance of nutrition and a healthy ecology, of an environment free of toxins and pollution, need hardly be stressed. They, too, are social issues more than individual ones.

I’m often asked how people should approach their physicians, who may be very adept at their craft but limited by the narrowness of the medical ideology. “It’s the same as going to a bakery,” I reply. “When you enter a bakery, don’t ask for salami, just as when you go to the butcher, it is no use to ask for cookies.” Receive, I suggest, what the physician can offer — and often that can be miraculous — but do not seek what the doctor cannot. Find alternative sources for what most physicians cannot provide: a holistic approach that considers not organs and systems but the entire human organism. Take responsibility for how you live, the food you ingest, your emotional balance, your spiritual development, the integrity of your relationships.

Give yourself, as best you can, what your parents would have loved to grant you but probably could not: full-hearted attention, full-minded awareness, and compassion. Make gifting yourself with these qualities your daily practice.

“A culture can be toxic or nourishing,” writes Thom Hartmann. If we wish to take full responsibility for health in our society, we must not only be vigilant guardians of our personal well-being, we must also work to change structures, institutions, and ideologies that keep us mired in a toxic culture.

Gabor Maté, M.D., frequently addresses lay and professional audiences across North America and internationally. His books include When the Body Says No: Exploring the Stress-Disease Connection and In the Realm of Hungry Ghosts: Close Encounters With Addiction. drgabormate.com

Defying DementiaResearch shows strong social ties slow it down

Marcus Harrison Green

Paul and Alice Padilla, at left, during a recent Momentia walk through Woodland Park Zoo in Seattle. Alice, 63, was diagnosed with dementia two years ago. YES! Photos by Betty Udesen

Alice Padilla’s laugh cut through the air at Seattle’s Woodland Park Zoo. Fresh off an hour-long exhibit tour, she and 16 other friends sat in the zoo cafeteria, snacking on sugar cookies and mocking current bestsellers. The group could appear to be just another cluster of friends visiting the zoo. But they were there for another purpose, too: to provide joy as much as support. Part of a program called Momentia, more than half of the people in the group have dementia.

The day was, in effect, an act of defiance for the 63-year-old Padilla, who was diagnosed with dementia two years ago. By living wholly in the present, Padilla is fighting a disease that threatens to rob her of her memory.

The zoo trip was just one of a series of Seattle-area group activities, from strum and drum bands and rap performances to cafe talks and public policy advocacy, organized for Momentia members. Marigrace Becker, the program manager for the University of Washington Medicine Memory and Brain Wellness Center, co-founded Momentia three years ago to challenge the misconceptions typically associated with dementia.

Alice and Paul Padilla, standing, sing with fellow members of the Momentia Strum & Drum Band during Camp Momentia, an annual gathering in West Seattle for dementia patients and their families. “When you have these kind of people who watch out for each other, you can enjoy your life,” said Alice.

According to the Alzheimer’s Association, by 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5.1 million today to a projected 13.8 million. The estimate makes Momentia an imperative for Becker. She spent years volunteering with dementia support groups and, after brainstorming words that rhymed with the condition, came up with “Momentia” to capture the idea of celebrating life in the moment. Becker wanted more than a social service; she wanted empowerment.

“I was envisioning it more like the Occupy movement, [which] galvanizes people and energizes them to have a voice, to build dementia-friendly communities in their own ways,” she said.

Life in the NowMaking every day a good day despite Alzheimer's

While there is no cure for dementia or Alzheimer’s, studies suggest strong social ties can help ward off the diseases’ advance.

That was the goal of another event on a balmy Sunday in September, when more than 100 people with dementia and their families gathered in West Seattle for Camp Momentia. Becker said the annual event recognizes the “staying power” of those touched by the disease.

Padilla was among them. She joined in drumming and square dancing and then capped off the day with a group rendition of “When the Saints Go Marching In.” Her petite frame marched around the large circle of singing campers as they laughed at her impersonation of a Mardi Gras drum major.

“I am not sad or angry,” she said later. “I don’t have any of that because those things are easy to be if you have Alzheimer’s. When you have these kind of people who watch out for each other, you can enjoy your life.”

Why Manning Up Is the Worst Thing to DoCan we cure the toxicity of male trauma and the resulting masculinity disease?

Mark Greene

YES! Illustration by Pablo Iglesias

The traditional rules about how to be a “real man” in America are breaking down. Economic upheaval has shifted wage earning from men to their wives or partners. The rise of men as primary caregivers of their children is challenging our most fundamental assumptions about gender. The gay rights and trans rights movements are creating expansive new definitions of masculinity. Millennials are leading a much broader acceptance of diversity.

Mark Greene is the author of Remaking Manhood. He writes and speaks on men’s issues at Salon, The Shriver Report, the BBC, and The New York Times. He is an executive editor for The Good Men Project. Follow him on Twitter @megasahd.

This generation is witness to a collision between traditional masculinity and a new wave, one that values intimacy, caregiving, and nurturing. But many of us have spent our lives under immense pressure to stifle emotional expression of any kind. And we’re learning there’s a cost: Men are suffering higher rates of life-threatening disease, depression, and death. Simply put, the suppression of emotional expression in men is damaging their health and well-being.

If you’ve grown up in the United States, then you’re familiar with the Man Box, the longstanding rules of how to walk, talk, and sound like a man in America:

1. Real men don’t express a wide range of emotions. They limit

themselves to expressing anger or excitement.

2. Real men are breadwinners, not caregivers.

3. Real men are “alphas” and natural leaders.

4. Real men are authoritative and make all final decisions.

5. Real men are physically tough and sexually dominant.

These rules take hold early in our lives. Boys 4 and 5 years old are told to shake it off, man up, don’t be a crybaby, and, worst of all, don’t be a girl. This is because the Man Box devalues any form of emotional expression traditionally deemed to be feminine. A devastating result of this anti-feminine bias is that women, gays, and trans people face epidemic levels of bullying, rape, misogyny, homophobia, and violence.

The Man Box robs our sons of a lifetime of opportunities to develop their emotional capacities. Instead, they grow into emotionally isolated men who wall themselves off from the social connectivity central to healing and creating community. The resulting health effects are undeniable.

One in three men aged 45 or older reported themselves to be lonely or socially isolated, according to a 2010 survey conducted by AARP. The consequences of that social isolation can be fatal. Between 1999 and 2010, suicide among men aged 35–64 rose by nearly 30 percent, as reported by the Centers for Disease Control and Prevention. Although rates have been rising for both sexes, the study found that middle-aged men are three times likelier than women to end their own lives — 27.3 deaths versus 8.1 (per 100,000).

This point underscores the fact that friendships are not simply a feel-good issue. They are a life-or-death issue. —Niobe Way, NYU professor of applied psychology

But the risks of social isolation are not just psychological; the absence of robust social relationships has a direct measurable impact on men’s physical health. A 2004 medical study based in Sweden showed that for middle-aged men, having a strong social network and sense of belonging lowered their risk of heart attack and fatal coronary heart disease; inversely, low social support predicted a risk.

The study further confirms that the risk of mortality for poor social relationships is comparable to risk factors like smoking and alcohol consumption, writes Niobe Way, author of Deep Secrets and professor of applied psychology at New York University. “This point underscores the fact that friendships are not simply a feel-good issue — they are a life-or-death issue.”

Add to this epidemic of emotional isolation the physical impact of unresolved trauma in men’s lives, and the combined effects are devastating. In The Body Keeps the Score, psychiatrist and PTSD researcher Bessel van der Kolk explores his decades-long work treating victims of catastrophic trauma. In 1978, he joined the Boston Veterans Administration Clinic as a staff psychiatrist. There, working with veterans of the Vietnam War, van der Kolk began to see the patterns that mark our modern-day understanding of trauma.

He learned that the human body, when confronted with trauma, can etch horrific memories in the brain, literally reorganizing our perceptions and imagination. The most harmless sounds can trigger flashbacks. One veteran, upon hearing a baby crying, “found himself suddenly flooded with unbearable images of dying children in Vietnam.” He was stuck, in effect, in a terrible loop, revisiting the events over and over again.

One of the many physiological responses to trauma can be seen in a region of the brain called Broca’s Area, which freezes up during flashbacks. This region of the brain is where we construct language to define and interpret our experience of the world. Is it any wonder people find it deeply challenging to put their experiences of trauma into words? Our own physiology is telling us it’s better to remain silent, making trauma all the harder to share or process.

And what exactly qualifies as trauma? Is it only present after catastrophic events or can it also take hold in the smaller brutalities of daily life, on playgrounds or in locker rooms? How much unresolved trauma do men carry after decades of emotional suppression?

I can recall, as a 7-year-old, seeing my home disappear out the back window of a car as a bitter divorce and my mother’s new marriage drew me away. I recall my brother taking out his shock and rage on me for 15 years afterward. I still flash back to the suffocating bullying and violence that ran rampant throughout my years of school and Scouts. And yet, when is any man encouraged to share such stories? For generations, talking about such things was antithetical to our culture’s insistence on male toughness. Thankfully, this is changing. As an editor for the Good Men Project, a website devoted to modern masculinity, I see thousands of men’s stories being told. But we need to hear more. Millions more.

If we are to empower our sons and improve men’s lives — and their health — we must tear down the walls of the Man Box, encouraging boys and men to express their full emotional range.

Trauma and the Man Box are mutually reinforcing. If, as men, we do not share our feelings, we will accrue decades of painful hidden stories, some of which will play over and over, triggering depression, fear, and unresolved anger toward ourselves and those we love.

Van der Kolk writes, “Everything about us — our brains, minds, and our bodies — is geared toward collaboration in social systems. This is our most powerful survival strategy, the key to our success as a species, and it is precisely this that breaks down in most forms of mental suffering.”

If we are to empower our sons and improve men’s lives — and their health — we must tear down the walls of the Man Box, encouraging boys and men to express their full emotional range. The path forward begins in our homes. In small, ongoing daily conversations, we can encourage our sons to explore their internal emotional landscapes, sharing those profound discoveries of life. The result will be countless authentic human moments, strung out across decades, each one growing the rich tapestry of human connection and capacity.

The cost of failing to do so is incalculable. Without the robust social networks that emotional expression creates, men will continue to suffer social isolation and shorter, sicker lives.

Van der Kolk defines humans as powerfully resilient and resourceful creatures, able to move beyond the challenging events of our lives and heal. But to do so, men must collaborate, connect, and share our stories, no matter how difficult they may be to tell.

And everyone else? They need to listen.

Mark Greene is the author of Remaking Manhood. He writes and speaks on men’s issues at Salon, The Shriver Report, the BBC, and The New York Times. He is an executive editor for The Good Men Project. Follow him on Twitter @megasahd.

Online Exclusive

Maintaining Real Relationships in the Digital World

Miles SchneiÍderman

I use Facebook every day, multiple times a day. It’s such an automatic activity at this point that I couldn’t even guess at an exact count. With the app for my phone, I can check Facebook as easily as I check the time. When I log in, my eyes dart to the small red number in the upper right-hand corner of the screen that tells me how much attention my status updates, shared links, and photos have received. Social media has become a fundamental part of my life. As an American in 2015, I am the rule, not the exception.

Miles Schneiderman is a regular contributor to YES!

And yet, a 2013 study from the University of Michigan found that as its 82 participants increased their Facebook use over two weeks, their happiness and sense of well-being declined. And in a 2012 study by Anxiety UK, a majority of participants said social media use was an overall negative experience. Seventy-one percent of adult Internet users in the United States use Facebook. Nearly three-quarters of them log on daily, and close to half log on several times every day. Those percentages are increasing. Why? The simple explanation is that it makes us feel good. A 2013 German study found that participants’ brains signaled a pleasure response when they received positive feedback on Facebook. The study concluded that the brain processed this positive feedback as gains in social reputation. There is satisfaction, almost a high, in seeing those red notification numbers, and more satisfaction when the numbers are higher. My Facebook “friends” — including personal friends, family members, acquaintances, and people in distant locations I’ve never actually met — are people I value and respect, and those red numbers assure me that I am a valued part of their lives, in turn.

“We know that many people on social media sites often present idealized versions of their lives, leading others to make upward social comparisons, which can lead to negative emotions,” said Benedictine University professor Shannon M. Rauch in an article on the website for Adolescent Growth, a California teen healthcare center.

I’ve experienced my share of this drawback of social media. Even as I’m happy for a friend who got a new job, or got married, or had a baby, I often find myself vaguely resentful of their accomplishments. Sometimes it seems like they’re rubbing their hyperidealized lives in my face, provoking feelings of inferiority and inadequacy by comparison.

In 2010, researchers at the Queensland University of Technology in Australia determined that social networking sites can positively impact adolescents who go online because they’re lonely.

But despite these negative effects, recent research indicates that social media can actually be a positive force if properly managed. James Fowler of the University of California, San Diego was lead author of a 2014 report that suggests social media can be harnessed to spread happiness through a ripple effect. The report found that positive Facebook status updates tend to lead to other, similar statuses. Fowler proposes that this effect could potentially be cultivated to create what he calls “an epidemic of well-being.”

For teenagers and young adults whose high levels of social media consumption are often used to portray them as born narcissists, the benefits can be even more dramatic. In 2010, researchers at the Queensland University of Technology in Australia determined that social networking sites can positively impact adolescents who go online because they’re lonely. These teens can find intimacy and social anxiety relief through online communication, which protects them from feelings of shame that limit their ability to express themselves. Instead of using online platforms as their own personal spotlights, many kids are using social media to reach out, to form bonds, and to try to find their place in the lives of others. Instead of seeking praise, they are seeking community.

This has been the key distinction in improving my own relationship with social media. I find happiness in community, and in many ways, social media has become that community, the first place I go every day for human connection. In part, this is a function of moving to a new city and leaving 30 years’ worth of in-person relationships behind. I’ve found new people to interact with, of course, but I’ve also maintained connections with people I would otherwise have fallen out of touch with. At the same time, I’ve expanded my personal community to include people whose faces I could only recognize from profile pictures. I’ve been invited to parties and protests that I wouldn’t have otherwise known about. I’ve found opportunities to advance both my career and my creative endeavors.

And others have embraced the possibility of an online community to even greater degrees. I’ve seen people turn to social media for help on every level, from asking friends to assist in a move, to seeking support for the revelation of a sexual preference or an eating disorder. It doesn’t replace individual relationships, but it does facilitate increased connection with a broader group of people. When I’m having a bad day, I use my phone to call a close friend or a parent. When I need to reach out to the larger network I’ve developed over the years, I use my phone to log on to Facebook.

Our responsibility is to foster a healthy relationship with social media by examining and understanding it in communal terms, while maintaining a balance between the digital and analog methods of experiencing the world.

Social media becomes emotionally unhealthy when we see it as a source of individual validation instead of a structure for community growth. The same can be said of our in-person interactions. As we work to maintain the health of our communities, it’s important to include online networks in our endeavors. This technology is not going away, and while it has intrinsic biases like any medium, its overall effects depend entirely on how it’s applied. Our responsibility is to foster a healthy relationship with social media by examining and understanding it in communal terms, while maintaining a balance between the digital and analog methods of experiencing the world.

Finding that balance is a constant struggle, and I would never claim to have achieved it myself. But I have learned to look at the trials and successes of the people who comprise my Facebook feed not as standards of measurement by which to judge myself, but as sources of connection and inspiration. The little red notification numbers in the upper right hand corner of the screen pale in importance against the platform as a whole — the living and changing network of digital relationships that is rapidly becoming the modern community.

Income Inequality Is a Health Hazard — Even For the Rich

2015 YES! Infographic
SOURCE: American Journal of Public Health.
January 2002 Study: "Income Inequality and Mortality in U.S. Counties"

Wealth in the United States can buy many things: education, homes, vacations. It can even buy the best doctors and diet, but it can’t buy health. Why not?

Ask Stephen Bezruchka, a public health researcher at the University of Washington. While training Nepalese doctors and students in 1991, he stumbled upon research that revealed a disturbing trend in U.S. health indicators: Life expectancy was falling behind other developed countries while mortality rates were rising past them. He wondered why.

After leaving a career in medicine to study public health, he was shocked to learn that people in more economically unequal societies live shorter lives. What was startling was that this was true even for the rich. In the U.S., the most affluent die at a greater rate (912.2 per 100,000) in counties with higher income inequality than the poorest (883.3 per 100,000) in counties with lower income inequality. More than 170 studies support such findings.

Researchers don’t know why, but they have theories. Some say more people in unequal societies can’t buy what they need to stay healthy. That’s the materialist perspective. Bezruchka subscribes to the psychosocial theory, which assumes people are more influenced by societal expectations than their own needs. In the United States, individuals are expected to go the extra mile to fulfill responsibilites — rich or poor. What does this all inevitably lead to? Stress.

Health functions at the macro level, and it can’t be improved unless structural problems are addressed and solutions are offered. That includes early-life programs. Bezruchka is now working with Washington Physicians for Social Responsibility to support a paid family leave act, because a baby’s first thousand days are some of its most critical.

“Roughly half of our health as adults today is determined sometime between conception and before you go to school,” Bezruchka explained. “Hillary Clinton used the term ‘the first thousand days,’ and that is sort of a label for nine months in utero and the first two years afterward.”

The United States needs a lot more than a thousand days to catch up to the rest of the developed world. It would actually need at least a generation, maybe two. Until then, the rich and poor alike will continue to suffer the effects of income inequality. But catching up starts with change. Just ask Bezruchka.